Consequences of the SARS-CoV-2 Pandemic on Mental Health: Integrative Review

The lack of specific treatment and knowledge about the exact pathophysiology of the 2019 Coronavirus disease (COVID-19) and its vaccines makes the organic aspects of the pandemic a concern and puts the psychiatric consequences and psychological effects of SARS-CoV-2, COVID-19, in second place. Hence, the psychiatric impacts of the COVID-19 pandemic have not been well established yet. We have performed an integrative literature review in three electronic databases: Medline, PsycINFO, and Published International Literature on Traumatic Stress (PILOTS). The findings were then divided into five subcategories: impacts of COVID-19 on the mental health of psychiatric patients; use of technology as an ally in combating impacts on mental health in the context of the COVID-19 pandemic; mental health promotion measures in the context of the COVID-19 pandemic for the population; mental health promotion measures in the context of the COVID-19 pandemic for health professionals; and mental health in specific groups in the context of the COVID-19 pandemic. This study has showed that the situation and measures proposed to fight the COVID-19 pandemic cause stress, anxiety, fear, and uncertainty in the population. Psychiatric patients, the elderly, refugees, and migrant workers are more vulnerable due to the stigmatization and lack of specialized support in health services and reduced access to medications. Therefore, they require care from governments and health authorities. In addition, measures to promote hospital health for health professionals seem to be essential to improve care and reduce the psychologic/psychiatric impacts on professionals. Thus, technology is a valuable ally in this process.

The global impact on mental health almost 2 years into the COVID-19 pandemic

Approaching 2 years into a global pandemic, it is timely to reflect on how COVID-19 has impacted the mental health of the global population. With research continuing apace, a clearer picture should crystallise in time. COVID-19 has undoubtedly had some impact on population mental health, although the severity and duration of this impact remain less clear. The exceptional period of COVID-19 has provided a unique prism through which we can observe and consider societal mental health. This is a momentous time to be involved in mental health research as we strive to understand the mental health needs of the population and advocate for adequate resourcing to deliver quality mental healthcare in the post-pandemic period.

Public mental health: a psychiatry and public health perspective

Mental health issues are fast becoming one of society’s greatest health challenges with evidence of higher levels of illness and strain on psychiatric services. The reasons for this trend of increasing mental health problems across the population are complex and there is an urgent need to research and deliver effective public mental health strategies. In this perspective piece we argue that psychiatrists and public health physicians have unique knowledge and perspectives on population mental health. The development of interdisciplinary initiatives and training posts would result in clinicians with expertise to drive forward public mental health strategies. Focused and sustained advocacy and collaboration are necessary for prioritisation of public mental health on policymakers’ agendas.

Rapid national increases in the hospitalisation of Australian youth due to intentional self-harm between 2008 and 2019

Objective: Australian youth mental health services have received significant funding over the past 15 years. We analysed data on hospitalisation due to intentional self-harm to determine whether increased youth services were associated with reduction in a key indicator of youth population mental health. Method: Trends in national self-harm hospitalisation data from 2008 to 2019 for youth (<25 years) and adults (>25 years) were analysed using joinpoint regression. Results: Rates of hospitalisation due to intentional self-harm increased significantly in both male (1.1% per annum, 95% CI [0.2%, 1.9%]) and female (3.0% per annum, 95% CI [0.9%, 5.1%]) youth aged <25 years between 2008 and 2019. Female youth had higher rates of hospitalisation than males, and there were average annual increases of 9.1% (95% CI [2.4%, 16.3%]) and 4.0% (95% CI [0.1%, 7.9%]), and absolute increases of 120% and 47.9%, in the rate of hospitalisation of females aged 0–14 and 15–19, respectively. In contrast, there was no overall change in adults (>25 years). Conclusions: Rates of hospitalisation due to intentional self-harm in Australian youth have increased despite significant investment in youth mental health services. This result could be attributable to several sociocultural factors and suggests a critical need for more hospital-based emergency youth mental health services.

The Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA): Aims, model, outputs, and implications for clinical academic advocacy

Objective: We describe an independent model of clinical academic mental health services research that is able to provide synthesised views for medico-political organisations that are engaged in advocacy for national and state evidence-based policy and planning of mental healthcare. Conclusions: CAPIPRA focuses on independent research and policy analysis using publicly available datasets on population mental health at national and state/territory levels, published in international and national peer-reviewed journals (>50 papers since 2019). We partner with medico-political organisations in evidence-based advocacy across a wide range of issues.

The Psychological Benefits of COVID-19 Vaccination

This study evaluates the extent to which COVID-19 vaccination affects population mental health. Exploiting the within-state and within-survey week variation in the number fully vaccinated per 10 million people, I uncover the favorable effects of vaccination on individuals’ psychological well-being. Particularly, a 100% increase in the number fully vaccinated per 10 million people makes individuals 0.24, 0.23, 0.12, and 0.14 percentage points less likely to experience anxiety, worry, displeasure, and depression on a daily basis, respectively. The probability of having at least one of the four symptoms (anxiety, worry, displeasure, and depression) every day also reduces by 0.27 percentage points. The study calls for the expansion of vaccine coverage, especially for disproportionately affected communities.

Psychological Distress Before and During the COVID-19 Pandemic: Sociodemographic Inequalities in 11 UK Longitudinal Studies

Background: How population mental health has evolved across the COVID-19 pandemic under varied lockdown measures is poorly understood, with impacts on health inequalities unclear. We investigated changes in mental health and sociodemographic inequalities from before and across the first year of the pandemic in 11 longitudinal studies. Methods: Data from 11 UK longitudinal population-based studies with pre-pandemic measures of psychological distress were analysed and estimates pooled. Trends in the prevalence of poor mental health were assessed across the pandemic at three time periods: initial lockdown (TP1, Mar-June 20); easing of restrictions (TP2, July-Oct 20); and a subsequent lockdown (TP3, Nov 20-Mar 21). Multi-level regression was used to examine changes in psychological distress compared to pre-pandemic; with stratified analyses by sex, ethnicity, education, age, and UK country. Results: Across the 11 studies (n=54,609), mental health had deteriorated from pre-pandemic scores across all three pandemic time periods (TP1 Standardised Mean Difference (SMD): 0.13 (95% CI: 0.03, 0.23); TP2 SMD: 0.18 (0.09, 0.27); TP3 SMD: 0.20 (0.09, 0.31)). Changes in psychological distress across the pandemic were higher in females (TP3 SMD: 0.23 (0.11, 0.35)) than males (TP3 SMD: 0.16 (0.06, 0.26)), and slightly lower in below-degree level educated persons at some time periods (TP3 SMD: 0.18 (0.06, 0.30)) compared to those who held degrees (TP3 SMD: 0.26 (0.14, 0.38)). Increased distress was most prominent amongst adults aged 35-44 years (TP3 SMD: 0.49 (0.15, 0.84)). We did not find evidence of changes in distress differing by ethnicity or UK country. Conclusions: The substantial deterioration in mental health seen in the UK during the first lockdown did not reverse when lockdown lifted, and a sustained worsening is observed across the pandemic. Mental health declines have not been equal across the population, with females, those with higher degrees, and younger adults more affected.

Mobile Applications in Mood Disorders and Mental Health: Systematic Search in Apple App Store and Google Play Store and Review of the Literature (Preprint)

BACKGROUND There are thousands of health apps available, including for mood disorders. However, their access is unstructured, and most are never download nor used. Their outcomes are rarely systematically measured and therefore effectiveness is disputed, even potentially damaging. The COVID-19 pandemic has posed and continues to pose a significant burden on population mental health, yet it has also given rise to rapid eHealth development. However, despite increasing reliance on eHealth solutions, major knowledge gaps on their utility and effectiveness persist. OBJECTIVE The main objective of this work was to explore and characterize the current landscape of mobile applications available to treat mood disorders such as depression, bipolar disorder, and dysthymia. METHODS We developed a tool that makes both the Apple App Store and the Google Play Store searchable using keywords and that facilitates the extraction of basic app information of the search results. All app results were filtered using various inclusion and exclusion criteria. We characterised all resultant applications according to their technical details. Furthermore, we searched for scientific publications on each app’s website and PubMed, to understand whether any of the apps were supported by any type of scientific evidence on their acceptability, validation, use, effectiveness, etc. RESULTS Thirty apps were identified that fit the inclusion and exclusion criteria. The literature search yielded 27 publications related to the apps. However, these did not exclusively concern mood disorders. 6 were randomised studies and the rest included a protocol, pilot-, feasibility, case-, or qualitative studies, among others. The majority of studies were conducted on relatively small scales and 9 of the 27 studies did not explicitly study the effects of mobile application use on mental wellbeing. CONCLUSIONS While there exists a wealth of mobile applications aimed at the treatment of mental health disorders, including mood disorders, this study has shown that only a handful of these are backed by robust scientific evidence. This result uncovers a need for further clinically-oriented and systematic validation and testing of such apps.

Covid-19 and population mental health in perspective

COVID-19 was accompanied by an increase in common mood-anxiety disorders in populations worldwide. This increase is consistent with what has been observed after other prior large-scale disasters but is larger in scale, scope, and duration. This has important implications both for our understanding of population mental health, and for how we may mitigate the mental health consequences of large-scale events.